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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5260

2. Registrant Information.

Registrant Reference Number: SC692734

Registrant Name (Full Legal Name no abbreviations): Dow AgroSciences Canada Inc.

Address: 450-1st Street SW, Suite 2100

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2P 5H1

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: OKLAHOMA

6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-182

Product Name: Grazon P+D Herbicide

  • Active Ingredient(s)
      • Guarantee/concentration 39.6 %
      • Guarantee/concentration 10.2 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 62719-182

Product Name: Remedy Ultra Herbicide

  • Active Ingredient(s)
      • Guarantee/concentration 60.45 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Unknown

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Blood
    • Symptom - Anemia
    • Symptom - Leukocytosis
    • Symptom - Thrombocytopenia
  • General
    • Symptom - Cancer
    • Specify - Cancer NOS
  • Respiratory System
    • Symptom - Pneumonia
    • Specify - Pneumonia

4. How long did the symptoms last?

>2 mos and <=6mos />2 mois et <=6mois

5. Was medical treatment provided? Provide details in question 13.


6. a) Was the person hospitalized?


6. b) For how long?


Day(s) / Jour(s)

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

9/15/2010 1:37:46 PM Caller states that he sprayed about 800 acres with Grazon 05/18/2010 and he was hospitalized with chemical pneumonia and thrombocytopenia from 05/19/2010 until 07/01/2010. He is unable to recount any specific instance of exposure or spray drift. He was not wearing personal protective equipment. He assumes the exposure somehow occurred by virtue of his being the applicator. He had a bone marrow test done in July 2010. Caller was diagnosed with myleodysplasia syndrome that caller states is turning into Leukemia. The doctor's have not indicated that the Grazon was the cause of his cancer. Caller relayed that in addition to the Grazon, he used Remedy Ultra and 2,4-D while spraying. The spraying was done for a neighbor. He is not a licensed applicator and he did not use personal protective equipment while spraying. He was just able to find out what he sprayed with yesterday and he is calling to report this incident. He has declined chemotherapy at this time.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. When considering the body of regulatory data as well as the weight of scientific peer reviewed evidence involving the contents of this pesticide, any relationship between the single acute use of this product and the development of cancer/neoplasia is inconceivable and lacks any biological plausibility. First, the ingredients are not known to be carcinogenic at application concentrations following a single application, but more importantly, the type of physiological abnormality described with regard to this patient's diagnosed disease is chronic in its development where several months to years are required before overt clinical signs and symptoms become manifest.